Friday, January 14, 2011

There's a huge ethical debate among the organ transplant community, especially the kidney folks, about whether or not organ donors should be compensated in some way for their donation. In other words, sell their organs. The big selling point for allowing compensation will be that there will be a much larger pool for contributed body replacement parts (kidneys, bone marrow, non-death-requiring parts) for those who desparately need them, rather than a waiting list that people can hang on for years. The big ethical sticker is that people would commidify body parts and people would sell organs not because they want to, but because they need to (an example of a 14 year old selling a kidney to a medical tourist in Manila, Philipenes is a prime example of abusive organ selling). Some of these medical and ethical experts think that paying people for organs would reduce the supply of cadaveric organs, like hearts, simply because people would fear being put to death sooner for the money.

The one problem I've never seen one of these bioethics debates hit is the Marxist argument. What happens when body parts are commodified? I'm not speaking of what happens on the seller's side, but what happens on the buyer's side. Who pays for the organ compensation? Image you have two patients that need a heart. The donor is to be compensated for it at a set price (let's assume that compensation prices will be set simply to avoid turning the organ commidity market into a bidding war). One person is well off, one person is not. Who pays? In theory, insurance, right? The first mistaken assumption is that insurance will pay for all of it. Deductables, you know? And insurance companies are in business to make profit, not to pay out money (it's why we really need pre-existing condition reform, whatever happens in the future). So Well Off Patient's family writes a check. Maybe they need to get a home equity loan or something, but they can pony up the cash for whatever insurance will totally refuse to cover, providing insurance even agrees to ever cover any of the sale price for a heart. Not So Well Off Patient's family does what? Holds bake sales, puts up charity change jars at convenience store counters, borrows every dime from everyone they know. Who gets the organ? Honestly? In the end, the trend will simply be this: the people who get organ transplants are the ones who can afford to buy the organ. The people who do not get organ transplants are the ones who cannot afford to buy the organ.

I can say this because it's already true. In places where buying organs is either not illegal or, if it is illegal, no one does a damned thing about it, that's what's going on.

How does class warfare figure into the ethical argument? Very simply, when you have a valuable commodity where there is more demand than supply, the upper classes own and control it, the lower classes do without. It's simple capitalism. So what happens when the lower classes understand that their loved ones have less access to organs that will save their loved one's lives simply because the rich people get first crack? Yeah. It won't be pretty.